Normal labour and delivery Flashcards Preview

Stage 3: EJR - Obstetrics > Normal labour and delivery > Flashcards

Flashcards in Normal labour and delivery Deck (34):
1

Gestation of normal (not premature) delivery

37-42 weeks

2

Exact definition of labour

Painful contractions leading to effacement and dilation of cervix

3

What to ask in taking history of woman who thinks she is in labour

-CONTRACTIONS: frequency, duration, onset
-MEMBRANES: ruptured or intact

4

What to examine in woman who thinks she is in labour

-Maternal obs
-Urine
-Abdominal palpation
-Foetal movements
-May auscultate heart
-+/- vaginal exam to diagnose onset of labour

5

Role of prostaglandins in labour

-reduces cervical resistance
-increases release of oxytocin from posterior pituitary gland

6

3 mechanical factors of labour

1. powers
2. passage
3. passenger

7

Describe the 3 stages of labour

1. Initiation -> full cervical dilation
2. full cervical dilation -> foetal delivery
3. foetal delivery -> delivery of placenta

8

How long should the 1st stage of labour take on average

12h in nulliparous
7.5h in multiparous

9

What is considered adequate level of contractions

4-5 contractions every 10min

10

Most common presenting part of foetus (>95% of cases)

Most common presenting part of foetus (>95% of cases)

11

Where is the vertex of the foetus

Diamond shaped area between anterior and posterior fontanelles, between parietal eminences

12

How long should the active part of the 2nd stage take on average

40min in nulliparous
20min in multiparous

13

What is a normal level of bleed loss in the 3rd stage

500ml

14

How often should foetal monitoring be carried out during 1st stage of labour

Every 15min

15

How often should foetal monitoring be carried out during 2nd stage of labour

Every 5min

16

Non-pharmacological analgesia during labour

Hypnosis
TENS
Water birth
Acupuncture

17

Pharmacological analgesia during labour

Paracetamol
Dihydrocodeine
Entonox (NO + O2)
Diamorphine + metoclopramide
Epidural

18

Maternal reasons for continuous monitoring during birth

• Rhesus incompatibility
• Hypertension/ PIH/ pre-eclampsia
• Diabetes
• Antepartum haemorrhage
• Epilepsy, CVS conditions, renal conditions

19

Foetal reasons for continuous monitoring during birth

• IUGR
• oligohydramnios
• Abnormal doppler velocimetry
• Preterm
• Multiple pregnancy
• Breech pregnancy
• Pregnancy >42w

20

Labour reasons for continuous monitoring during birth

• Use of syntocinon
• VBAC
• Prolonged ROM >18-24h
• Suspicious HR on auscultation using pinnard
• Epidural insitu
• By request (age, poor obstetric history)
• Baby has passed meconium

21

How to interpret a CTG (cardiotography)

DR C BRaVADO

• Define risk
• Contractions
• Baseline Rate
• Variability
• Accelerations
• Decelerations
• Overall impression

22

What is the normal baseline heart rate in a CTG

110-160bpm

23

Reasons for foetal bradycardia in CTG

• Gestation >40w
• Cord compression
• Congenital heart malformations
• Congenital heart block
• Drugs eg benzodiazepine

24

Reasons for foetal tachycardia in CTG

• Excessive foetal movement
• Maternal anxiety
• Gestation <32w
• Maternal pyrexia
• Foetal infection
• Chronic hypoxia

25

What does variability in a CTG indicate

Intact integration between CNS and heart of foetus

More wiggly line (>5) is better

26

What is considered an acceleration in a CTG?

What does this indicate?

Increase of >15bpm above baseline for at least 15s

Indicates moving, stimulation

27

What in a CTG is the best indicator of foetal well being

Accelerations

28

What do early decelerations in a CTG indicate

Mirrors contraction

29

What do late decelerations in a CTG indicate

Associated with foetal hypoxia.

Ominous if foetus has also passed meconium.

30

What is considered a sinusoidal pattern in a CTG

Amplitude of 10bpm in cycle of 2-5 per minute. Lasts >2min

31

What is a sinusoidal pattern in a CTG associated with

Severe foetal anaemia and hydrops

(but may also occur with thumb sucking)

32

Components of Bishop score

• Cervix dilation
• Cervix consistency: firm to soft
• Length of cervix
• Cervix position: posterior/ central/ anterior
• Station of presenting part (cm above ischial spin)


the higher the score, the more likely labour will commence soon

33

Components of APGAR score

Appearance
Pulse
Grimace
Activity (floppy or normal muscle tone)
Respiration

34

In foetal scalp blood sampling, what levels of pH and lactate would require intervention

o Scalp blood pH<7.2
o Lactate >4.8